Coronary Artery Disease, Myocardium; Injury
Conditions
Brief summary
This is a cross-sectional pilot study to assess coronary artery disease with minimal invasive techniques in patients with asymptomatic troponin elevation after noncardiac surgery. The primary objective is to quantify coronary artery disease, as determined by coronary CT and MR, as a cause of postoperative myocardial injury. The secondary objective is to correlate coronary calciumscore to postoperative levels of troponin.
Interventions
OTHERMinimal invasive cardiac imaging
* Coronary CT angiography (CCTA) * Coronary magnetic resonance imaging (CMR) * Echocardiography
Sponsors
UMC Utrecht
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Major noncardiac surgery with a planned minimal postoperative hospital stay of 2 days * Age \> 59 years * Troponin\_I elevation \> 0.06 ng/ml in the first 3 post-operative days * No clinical symptoms of myocardial ischemia
Exclusion criteria
* Perioperative troponin elevation due to other factors than coronary artery disease such as proven pulmonary embolism or sepsis * Perioperative ST-elevation myocardial infarction (STEMI) * Perioperative symptomatic angina with troponin elevation * Patients with a history or ECG-signs of myocardial infarction * Patients with pre-existent heart failure, left ventricular dysfunction, significant valvular disease or left ventricle hypertrophy * Patients with significant valvular disease or left ventricle hypertrophy determined postoperatively with echocardiography. * Contra-indication for CMR such as claustrophobia or metal prosthesis * Allergic reaction to CT-contrast or gadolinium * Renal dysfunction with GFR \< 50 ml/min, as determined after the operation * Unstable hemodynamics or other conditions disabling transport to the Radiology department * Expected major discomfort or substantial increase in pain sensation by undergoing CCTA or CMR * Admission at the ICU * Poor prognosis due to other medical conditions e.g. malignancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Coronary artery disease | During hospital admission | Coronary artery disease with luminal narrowing \> 50 % in one or more major epicardial vessels by CCTA. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Coronary calcium score | During hospital admission | Agatston coronary calcium score |
| Extent of coronary artery atherosclerosis | During hospital admission | Presence and extent of coronary artery atherosclerosis as measured with coronary CCTA |
| Minimal myocardial injury | During hospital admission | Minimal myocardial injury measured by late gadolinium enhancement on CMR. |
Countries
Netherlands
Contacts
Primary ContactHendrik M. Nathoe, MD PhD
Outcome results
None listed